Citation Information :
Nada AA, Hammad ME, Eltanahy AF, Gazar AA, Khalifa AM, El-Sayed MH. Acute Correction and Plate Fixation for the Management of Severe Infantile Blount's Disease: Short-term Results. 2021; 16 (2):78-85.
Purpose: The purpose of this study is to evaluate the short-term results of lateral closing wedge osteotomy with medial hemiplateau elevation for the management of severe infantile Blount's disease.
Materials and methods: In this prospective study, 11 cases of severe Blount's disease (Langenskiold stages five and six) were managed in the period between January 2017 and January 2020. Double osteotomy technique was applied, namely a metaphyseal closing wedge and a medial hemiplateau elevation, through a single midline incision. Fixation was achieved by a medial anatomical locked plate. Patients were evaluated clinically according to a modified version of paediatric outcomes data collection Instrument (PODCI) and radiologically by measuring the angle between the tibial and the femoral shaft, the mechanical axis deviation (MAD) and the angle of the medial tibial plateau (MTP) depression.
Results: The average follow-up period was 2 years. Healing of the osteotomies was achieved in all cases after the index operation within an average of 3 months. Based on our modification of the PODCI score, five cases had an excellent outcome, five were good, and one case ended with a fair outcome. No major complications were encountered in this study.
Conclusion: The management of severe Blount's disease by acute correction using the aforementioned technique has been proven to achieve acceptable clinical and radiological outcomes without significant complications.
Level of evidence: Level IV case series study.
Phedy P, Siregar PU. Osteotomy for deformities in blount disease: A systematic review. J Orthop 2016;13(3):207. DOI: 10.1016/j.jor.2015.03.003.
Gkiokas A, Brilakis E. Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation. J Child Orthop 2012;6(5):4118. DOI: 10.1007/s11832-012-0443-x.
Johnston CE, Young M. Tachdjians Pediatric Orthopaedics, Disorders of the Leg. Fifth Edit. Tachdjians Pediatric Orthopaedics, 5/e. Elsevier Inc.; 2017. 713-760.e5 p.
Jones S, Hosalkar HS, Hill RA, Hartley J. Relapsed infantile Blounts disease treated by hemiplateau elevation using the Ilizarov frame. J Bone Joint Surg Br 2003;85(4):565–571. DOI: 10.1302/0301-620x.85b4.13602.
Griswold B, Gilbert S, Khoury J. Opening Wedge Osteotomy for the Correction of Adolescent Tibia Vara. Iowa Orthop J 2018;38:1416. PMID: 30104937.
Gregosiewicz A, Wośko I, Kandzierski G, Drabik Z. Double-elevating osteotomy of tibiae in the treatment of severe cases of Blounts disease. J Pediatr Orthop 1989;9(2):178–181. PMID: 2925852.
Fitoussi F, Ilharreborde B, Lefevre Y, Souchet P, Presedo A, Mazda K, et al. Fixator-assisted medial tibial plateau elevation to treat severe Blount's disease: Outcomes at maturity. 2011;1728. DOI:10.1016/j.otsr.2010.10.002.
Langenskiöld A, Riska EB. Tibia vara (osteochondrosis deformans tibiae): a survey of seventy-one cases. JBJS 1964;46(7):140520. PMID: 14213402.
Daltroy LH, Liang MH, Fossel AH, Goldberg MJ. The POSNA pediatric musculoskeletal functional health questionnaire: report on reliability, validity, and sensitivity to change. J Pediatr Orthop 1998;18(5):56171. DOI: 10.1097/00004694-199809000-00001.
Krettek C, Miclau T, Gru O, Schandelmaier P, Tscherne H. Intraoperative control of axes, rotation and length in femoral and tibial fractures technical note. Injury 1998;29:29–39. DOI: 10.1016/s0020-1383(98)95006-9.
Oto M, Yilmaz G, Bowen JR, Thacker M, Kruse R. Adolescent Blount disease in obese children treated by eight-plate hemiepiphysiodesis. Eklem Hast ve Cerrahisi 2012;23(1):20–24. PMID: 22448825.
Rahman A, Amer AL, Khanpour AA. Evaluation of treatment of late-onset tibia vara using gradual angulation translation high tibial osteotomy. Acta Orthop Belg 2010;76(3):360–366. PMID: 20698458.
van Huyssteen AL, Hastings CJ, Olesak M, Hoffman EB. Double-elevating osteotomy for late-presenting infantile Blounts disease. The importance of concomitant lateral epiphysiodesis. J Bone Jt Surg - Ser B 2005;87(5):710–715. DOI: 10.1302/0301 620X.87B5.15473.
Hofmann A, Jones RE, Herring JA. Blounts disease after skeletal maturity. J Bone Joint Surg Am 1982;64(7):1004–1009. PMID: 7118963.
Abraham E, Toby D, Welborn MC, Helder CW, Murphy A. New Single-stage Double Osteotomy for Late-presenting Infantile Tibia Vara: A Comprehensive Approach. J Pediatr Orthop 2019;39(5):247–256. DOI: 10.1097/BPO.0000000000000926.
Siregar P. Bamboo Osteotomy for Blounts Disease. Malaysian Orthop J 2010;4(1):56–59. DOI: 10.5704/MOJ.1003.013.
Van Houten AH, Heesterbeek PJC, Van Heerwaarden RJ, Van Tienen TG, Wymenga AB. Medial open wedge high tibial osteotomy: Can delayed or nonunion be predicted? Clin Orthop Relat Res 2014;472(4):1217–1223. DOI: 10.1007/s11999-013-3383-y.
Wright J, Calder P. Severe infantile blounts disease: Hemiplateau elevation and metaphyseal correction with use of the taylor spatial frame. J Limb Lengthening Reconstr 2018;4(2):76. DOI: 10.4103/jllr.jllr_2_18.
Feldman DS, Madan SS, Ruchelsman DE, Sala DA, Lehman WB. Accuracy of correction of tibia vara: acute versus gradual correction. J Pediatr Orthop 2006;26(6):794–798. DOI: 10.1097/01.bpo.0000242375.64854.3d.
Hefny H, Shalaby H, El-kawy S. A New Double Elevating Osteotomy in Management of Severe Neglected Infantile Tibia Vara using the Ilizarov Technique. 2006;26(2):233–237. DOI: 10.1097/01.bpo.0000218530.59233.ab.
Edwards TA, Hughes R, Monsell F. The challenges of a comprehensive surgical approach to Blounts disease. J Child Orthop. 2017;11(6): 479–487. DOI: 10.1302/1863 2548.11.170082.
Sachs O, Katzman A, Abu-johar E, Eidelman M. Treatment of Adolescent Blount Disease Using Taylor Spatial Frame With and Without Fibular Osteotomy: Is there any difference ? 2015;35(5): 501–506. DOI: 10.1097/BPO.0000000000000317.
Sasaki T, Yagi T, Monji J, Yasuda K, Kanno Y. Transepiphyseal plate osteotomy for severe tibia vara in children: follow-up study of four cases. J Pediatr Orthop 1986;6(1):61–65. PMID: 3941183.
Schoenecker PL, Johnston R, Rich MM, Capelli AM. Elevation of the medical plateau of the tibia in the treatment of Blount disease. J Bone Joint Surg Am 1992;74(3):351–358. PMID: 1548261.
Chotigavanichaya C, Salinas G, Green T, Moseley CF, Otsuka NY. Recurrence of varus deformity after proximal tibial osteotomy in Blount disease: long-term follow-up. J Pediatr Orthop 2002;22(5): 638–641. PMID: 12198467.
Lützner J, Gross AF, Günther KP, Kirschner S. Reliability of limb alignment measurement for high tibial osteotomy with a navigation system. Eur J Med Res 2009;14(10):447–450. DOI: 10.1186/2047-783x-14-10-447.
Yoon S-D, Zhang G, Kim H-J, Lee B-J, Kyung H-S. Comparison of cable method and miniaci method using picture archiving and communication system in preoperative planning for open wedge high tibial osteotomy. Knee Surg Relat Res 2016;28(4):283. DOI: 10.5792/ksrr.16.052.